Provider Demographics
NPI:1720411523
Name:KIMENG, LOUIS AFUMBOM
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:AFUMBOM
Last Name:KIMENG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 NIAGARA RD
Mailing Address - Street 2:SUITE 318
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1110
Mailing Address - Country:US
Mailing Address - Phone:301-982-6477
Mailing Address - Fax:301-982-6488
Practice Address - Street 1:4920 NIAGARA RD
Practice Address - Street 2:SUITE 318
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1110
Practice Address - Country:US
Practice Address - Phone:301-982-6477
Practice Address - Fax:301-982-6488
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP50021164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse